Factors associated with hospital readmission in sickle cell disease

<p>Abstract</p> <p>Background</p> <p>Sickle cell disease is the most frequent hereditary disease in Brazil, and people with the disease may be hospitalised several times in the course of their lives. The purpose of this study was to estimate the hazard ratios of factors associated with the time between hospital admissions.</p> <p>Methods</p> <p>The study sample comprised all patients admitted, from 2000 to 2004, to a university hospital in Rio de Janeiro State, south-east Brazil, as a result of acute complications from sickle cell disease (SCD). Considering the statistical problem of studying individuals with multiple events over time, the following extensions of Cox's proportional hazard ratio model were compared: the independent increment marginal model (Andersen-Gill) and the random effects model.</p> <p>Results</p> <p>The study considered 71 patients, who were admitted 223 times for acute events related to SCD. The hazard ratios for hospital readmission were statistically significant for the prior occurrence of vaso-occlusive crisis and development of renal failure. However, analysis of residuals of the marginal model revealed evidence of non-proportionality for some covariates.</p> <p>Conclusion</p> <p>the results from applying the two models were generally similar, indicating that the findings are not highly sensitive to different approaches. The better fit by the frailty model suggests that there are unmeasured individual factors with impact on hospital readmission.</p

Prevalência de internação hospitalar e fatores associados em Pelotas, RS

OBJETIVO: Estimar a prevalência de hospitalizações e identificar características associadas à internação hospitalar. MÉTODOS: Estudo transversal de base populacional realizado com indivíduos de ambos os sexos, de 20 a 69 anos, residentes na zona urbana de Pelotas, RS, entre 1999 e 2000. Foi utilizado questionário padronizado e pré-codificado. Foi realizada análise estratificada entre os sexos e controle de fatores de confusão por meio de Regressão de Poisson. Foram incluídas na análise variáveis socioeconômicas, demográficas, hábitos de vida, morbidades e consulta com médico no último ano. RESULTADOS: Dos 1.916 indivíduos, 146 (7,6%, IC95%:6,4;8,8) haviam sido hospitalizados no último ano desde a entrevista. Entre os homens, as características que se mostraram associadas a internação foram: idade de 50 anos ou mais, entre cinco e sete anos de escolaridade, ex-fumantes, distúrbios psiquiátricos menores e consulta com médico no último ano. Entre as mulheres com idade entre 60 e 69 anos, entre cinco e sete anos de escolaridade e consulta médica no período de um ano antes da entrevista, ocorreram maiores prevalências de hospitalização. As mulheres que consumiam menos de 30 g/dia de álcool mostraram menor freqüência de hospitalização. A prevalência de internação por causas sensíveis à atenção primária foi de 13,0% (IC 95%: 7,6;18,5). CONCLUSÕES: Homens e mulheres apresentaram prevalências semelhantes de internação hospitalar. Foi encontrada associação entre escolaridade e internação, mas não entre renda e internação

Health promotion in school environment in Brazil

ABSTRACT OBJECTIVE Evaluate the school environments to which ninth-year students are exposed in Brazil and in the five regions of the country according to health promotion guidelines. METHODS Cross-sectional study from 2012, with a representative sample of Brazil and its macroregions. We interviewed ninth-year schoolchildren and managers of public and private schools. We proposed a score of health promotion in the school environment (EPSAE) and estimated the distribution of school members according to this score. Crude and adjusted odds ratios (OR) were used, by ordinal regression, to determine the schoolchildren and schools with higher scores, according to the independent variables. RESULTS A student is more likely to attend a school with a higher EPSAE in the South (OR = 2.80; 95%CI 2.67&#8211;2.93) if the school is private (OR = 4.52; 95%CI 4.25&#8211;4.81) and located in a state capital, as well as if the student is 15 years of age or older, has a paid job, or has parents with higher education. CONCLUSIONS The inequalities among the country&#8217;s regions and schools are significant, demonstrating the need for resources and actions that promote greater equity